Double Closed-Loop Obstruction Caused by Right Paraduodenal Hernia With Intestinal Malrotation

Double closed-loop (DCL) obstruction is a rare but diagnostically important computed tomography (CT) finding observed in a subset of strangulated intestinal obstructions. A man in his 40s presented with sudden abdominal pain. CT demonstrated two simultaneous closed loop obstructions with a sac-like appearance, along with the superior mesenteric vein (SMV) rotation sign and absence of the duodenal horizontal segment, leading to a preoperative diagnosis of right paraduodenal hernia (RPDH) with intestinal malrotation. Emergency laparotomy was performed within three hours. Two closed loops of small bowel formed simultaneously, one inside and one outside a 3 cm hernial orifice on the dorsal ileocecal mesentery. Both loops resolved after reduction; the orifice was repaired without bowel resection. The patient was discharged on postoperative day 8. DCL obstruction is a rare but diagnostically valuable CT finding requiring prompt surgical intervention.